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Application- Lambertson-CDB-Withdrew 11-15-16
CITY OF ATLANTIC BEACH -WLO BOARD / COMMITTEE MEMBER APPLICATION FORM Please check (') the box beside each Board or Committee that you are applying to serve on. If you check more than one, please rank your interest in each board / committee by order of priority. (A summary of each board/committee is available on page 2 of this font.) z Code Enforcement Board 1'FCommunity Development Board Pension Board of Trustees Board Member Review Committee Cultural Arts and Recreation Advisory Committee DATE : i/c/I 6 APPLICANT' S NAME: 14J/g ; 5 ?30fv ADDRESS : 3 5-S- / 5 {, .4/64c &ei ( L- 3 'z 2 3 3 DAYTIME PHONE: ( b 1-( ' .3L-( �' - 2e6, D3 EVENING PHONE : 5 -e E-MAIL ADDRESS : Ch / 5 c) e lFeb o A,Le S f( C, FAX: elv ( - - 7'V6 Please explain any employment experience, board/committee experience, and/or community volunteer experience relative to the board/committee applying for. . • v5 C t 3 AA -o,, r-1 ! C'G, /4-■ r (v. 4 / ,j c cu 0 /4✓ A,vie 017 to /m �� :,4-er 4z l saw ��ik- 6-t o4 t y a L,.. (L.5 0,1,4 6 r t k t fr i (J :M .vI ' 7 S ( F V . e a?-MA-1 4✓ ) Please provide a brief explanation of your interest or any special qualifications you have in this field and your reasons for wishing to be appointed to this board/committee. 3,--r A- to, ;-1-tz (,„ a tic, t> 1 j 511-7.4 Hf-e r 0 07 zz , s t, - 4 (Le ✓r a ©c taci le4- pro ca,.ct Veci lY v��iCo ;E'►w- — ctti ce_d Fir ±�(- id! ti 67A- k(41-17u ,2_ /27A-A) de 5tyv ( 7 (1oj55 Please return completed foitn to Donna L. Bartle, City Clerk, 800 Seminole Road, Atlantic Beach, FL 32233 PLEASE NOTE: Members of the Code Enforcement Board, Community Development Board and Pension Board of Trustees are required to file Statement of Financial Interest Forms . Also, infot w.ation regarding "Conflict of Interest" is provided on page two of this application. This application will expire two (2) years after date of submittal. 1 '